Carotid Near-Occlusion: A Comprehensive Review, Part 1—Definition, Terminology, and Diagnosis

Johansson, Elias; Fox, Allan J.

doi:10.3174/ajnr.a4432

Cited by 70 publications

(113 citation statements)

References 74 publications

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“…2 Because some of the confusion in terminology definition and diagnosis is interwoven with prognosis, treatment, and pathophysiology, all issues are presented here.…”

Section: Confusion About Near-occlusionmentioning

confidence: 99%

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Carotid Near-Occlusion: A Comprehensive Review, Part 2—Prognosis and Treatment, Pathophysiology, Confusions, and Areas for Improvement

Johansson¹,

Fox²

2015

AJNR Am J Neuroradiol

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SUMMARY:In Part 1 of this review, the definition, terminology, and diagnosis of carotid near-occlusion were presented. Carotid nearocclusions (all types) showed a lower risk of stroke than other severe stenoses. However, emerging evidence suggests that the nearocclusion prognosis with full collapse (higher risk) differs from that without full collapse (lower risk). This systematic review presents what is known about carotid near-occlusion. In this second part, the foci are prognosis and treatment, pathophysiology, the current confusion about near-occlusion, and areas in need of future improvement.ABBREVIATIONS: ARR ϭ absolute risk reduction; CCA ϭ common carotid artery; ECA ϭ external carotid artery; PCA ϭ posterior cerebral artery; ECST ϭ European

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“…2 Because some of the confusion in terminology definition and diagnosis is interwoven with prognosis, treatment, and pathophysiology, all issues are presented here.…”

Section: Confusion About Near-occlusionmentioning

confidence: 99%

“…2,24 However, the impact of contralateral disease on collateral use and prognosis has not been studied. True hypoplasia is rare, between 0.01% and 0.24%.…”

mentioning

confidence: 99%

Carotid Near-Occlusion: A Comprehensive Review, Part 2—Prognosis and Treatment, Pathophysiology, Confusions, and Areas for Improvement

Johansson¹,

Fox²

2015

AJNR Am J Neuroradiol

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“…Carotid near-occlusion is a pattern-recognition diagnosis where interpretation of multiple key features is at the core of diagnosis [3]. These multiple key features have been presented before [4,5]: for both conventional angiography and CTA, side-to-side ICA difference and similar-sized or smaller ICA than ECA are features; for conventional angiography, delay of contrast and evidence of collaterals are features; and for CTA, absolute ICA size and impressive stenosis are features.…”

Section: Interpretative Approach To Near-occlusion Diagnosismentioning

confidence: 99%

Diagnosing carotid near-occlusion with 1 mm side-to-side asymmetry: a tough task made too easy

Johansson

Fox

2017

Neuroradiology

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In this issue of Neuroradiology, Koskinen and colleagues present their idea: that carotid near-occlusion (a tight stenosis that causes a collapse of the distal artery) can be separated from conventional ≥50% stenosis by measuring the distal diameter and all cases with ≥1.0 mm side-to-side difference is a nearocclusion [1]. Their goal was Bto facilitate the recognition and diagnosis of near-occlusion, and raise the notion that even when a subtle distal ICA LD [Luminal Diameter] reduction is present, a possible near-occlusion should be considered.^It is important to raise awareness of near-occlusions without full collapse, when the distal artery otherwise seems normal, albeit smaller than usual. Indeed, this issue is so important that we recently ranked it as one of the two major near-occlusion issues in most need of improvement [2]. Any neuroradiologist who is not well aware of the near-occlusion without full collapse would do well to apply this as a first step towards improved understanding. However, apart from raising initial awareness, we advocate against the use of this proposed 1.0 mm criterion for diagnosing near-occlusion. Interpretative approach to near-occlusion diagnosisCarotid near-occlusion is a pattern-recognition diagnosis where interpretation of multiple key features is at the core of diagnosis [3]. These multiple key features have been presented before [4,5]: for both conventional angiography and CTA, side-to-side ICA difference and similar-sized or smaller ICA than ECA are features; for conventional angiography, delay of contrast and evidence of collaterals are features; and for CTA, absolute ICA size and impressive stenosis are features. BImpressive^stenosis applies to when contrast is hardly (or no longer) seen in the stenosis [4] and remaining features are Bpositive^when visible to the eye of the observer. Studies with sensitivity and specificity of these features have compared to interpretation [4,5]. Hence, a previously reported 0.87 side-to-side ratio was an approximation of what was visible [4]. It is also important to interpret what is seen, such as whether side-to-side asymmetry is likely due to uniform collapse or something else such as old dissections or anatomical variance. An example of the interpretive approach using the illustrated case in the new article [1] is that there is a clearly visible side-to-side difference with uniform collapse where the distal artery otherwise seems normal (A + C), small absolute ICA size (B and provided measurement), ICA similar to ECA (A + C), and stenosis hard to assess due to calcifications. The interpretation of these findings is a nearocclusion without full collapse, and the interpretation seems certain from available information (even though the stenosis could not be clearly assessed, but it could be impressive). The interpretative approach is justified as it was used for the pooled NASCET and ECST analyses [5], from which we base our understanding of prognosis and management. While the definition of near-occlusion with interpretation might still...

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“…Carótidas com suboclusão com sinal do barbante podem ser incorretamente classificadas como oclusão completa através de exames não invasivos como a ultrassonografia (US) Doppler convencional e até por estudo angiográfico realizado inadequadamente 53,70 (Figura 4). haver placa calcificada no bulbo, o que dificulta a visualização.…”

Section: Diagnóstico Da Suboclusão Carotídeaunclassified

“…Evidencia vantagens em relação a essa última porque medidas precisas são realizadas em vários ângulos e por não haver risco de ocorrência de AVC durante o exame 83 . Assim, a angio-TC é o exame padrão-ouro atual para diagnóstico de suboclusão carotídea 70 .…”

Section: Diagnóstico Da Suboclusão Carotídeaunclassified

Resultados em longo prazo do tratamento de pacientes com suboclusão carotídea com sinal do barbante

Neves¹

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Carotid Near-Occlusion: A Comprehensive Review, Part 1—Definition, Terminology, and Diagnosis

Cited by 70 publications

References 74 publications

Carotid Near-Occlusion: A Comprehensive Review, Part 2—Prognosis and Treatment, Pathophysiology, Confusions, and Areas for Improvement

Carotid Near-Occlusion: A Comprehensive Review, Part 2—Prognosis and Treatment, Pathophysiology, Confusions, and Areas for Improvement

Diagnosing carotid near-occlusion with 1 mm side-to-side asymmetry: a tough task made too easy

Resultados em longo prazo do tratamento de pacientes com suboclusão carotídea com sinal do barbante

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